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Editor's Choice - A Systemic Evaluation of the Costs of Elective EVAR and Open Abdominal Aortic Aneurysm Repair Implies Cost Equivalence.
- Source :
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European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery [Eur J Vasc Endovasc Surg] 2020 Nov; Vol. 60 (5), pp. 655-662. Date of Electronic Publication: 2020 Aug 13. - Publication Year :
- 2020
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Abstract
- Objective: The suggested high costs of endovascular aneurysm repair (EVAR) hamper the choice of insurance companies and financial regulators for EVAR as the primary option for elective abdominal aortic aneurysm (AAA) repair. However, arguments used in this debate are impeded by time related aspects such as effect modification and the introduction of confounding by indication, and by asymmetric evaluation of outcomes. Therefore, a re-evaluation minimising the impact of these interferences was considered.<br />Methods: A comparative analysis was performed evaluating a period of exclusive open repair (OR; 1998-2000) and a period of established EVAR (2010-2012). Data from four hospitals in The Netherlands were collected to estimate resource use. Actual costs were estimated by benchmark cost prices and a literature review. Costs are reported at 2019 prices. A break even approach, defining the costs for an endovascular device at which cost equivalence for EVAR and OR is achieved, was applied to cope with the large variation in endovascular device costs.<br />Results: One hundred and eighty-six patients who underwent elective AAA repair between 1998 and 2000 (OR period) and 195 patients between 2010 and 2012 (EVAR period) were compared. Cost equivalence for OR and EVAR was reached at a break even price for an endovascular device of €13 190. The main cost difference reflected the longer duration of hospital stay (ward and Intensive Care Unit) of OR (€11 644). Re-intervention rates were similar for OR (24.2%) and EVAR (24.6%) (p = .92).<br />Conclusion: Cost equivalence for EVAR and OR occurs at a device cost of €13 000 for EVAR. Hence, for most routine repairs, EVAR is not costlier than OR until at least the five year follow up.<br /> (Copyright © 2020 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)
- Subjects :
- Aftercare economics
Aftercare statistics & numerical data
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal economics
Aortic Aneurysm, Abdominal mortality
Blood Vessel Prosthesis economics
Blood Vessel Prosthesis Implantation adverse effects
Blood Vessel Prosthesis Implantation instrumentation
Blood Vessel Prosthesis Implantation methods
Elective Surgical Procedures adverse effects
Elective Surgical Procedures instrumentation
Elective Surgical Procedures methods
Endovascular Procedures adverse effects
Endovascular Procedures instrumentation
Female
Hospital Mortality
Humans
Length of Stay economics
Length of Stay statistics & numerical data
Male
Middle Aged
Netherlands epidemiology
Postoperative Complications epidemiology
Postoperative Complications etiology
Reoperation economics
Reoperation statistics & numerical data
Retrospective Studies
Stents economics
Time Factors
Treatment Outcome
Aortic Aneurysm, Abdominal surgery
Blood Vessel Prosthesis Implantation economics
Cost-Benefit Analysis
Elective Surgical Procedures economics
Endovascular Procedures economics
Postoperative Complications economics
Subjects
Details
- Language :
- English
- ISSN :
- 1532-2165
- Volume :
- 60
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 32800479
- Full Text :
- https://doi.org/10.1016/j.ejvs.2020.07.012